Otolaryngology Coding Alert

Revised language should stop modifier 58 and 78 mixups You won't have to take a leap of faith when using modifiers 58 and 78 in the new year. CPT 2008 takes the gray out of these modifiers with several wording revisions. Zoom In on Planned or Unplanned Revisions to modifiers 58 and 78 should make distinguishing between the two modifiers easier. Modifiers 58 and 78 "were previously used interchangeably due to inadequate distinction between them," explains the AMA in CPT Changes 2008: An Insider's View. Protocol: Choose the correct modifier based on these guidelines: - modifier 58: warrants some level of planning or anticipation - modifier 78: reserve for procedures that are unplanned and not foreseen in advance. Check for Scheduled Language When your otolaryngologist performs a procedure that is staged or related to the global postoperative period of another procedure, you may use modifier 58 (Staged or related procedure or service by the same physician during the postoperative period). Identifying a staged surgery that the surgeon planned has always been straightforward. Example: An otolaryngologist places a trans-tracheal oxygen (O2) therapy tube. On day 1, the otolaryngologist performs a tracheostomy (31610, Tracheostomy, fenestration procedure with skin flaps). On day 2, during the second step of the procedure, the physician moves the O2 cannula of the long-term O2-use patient from the nose to the trachea (31730, Transtracheal [percutaneous] introduction of needle wire dilator/stent or indwelling tube for oxygen therapy). You code: Because the tracheostomy code (31610) used on day 1 has a 90-day global period, "we code 31730 with modifier 58 to let payers know we planned the tube placement at the time of initial service," says Karla M. Westerfield, business manager at Southeast Wyoming Ear, Nose & Throat Clinic PC, in Cheyenne. Look for these documentation clues that signal modifier 58's applicability. "During any global period, if the treating physician uses language that indicates that further procedures are scheduled during the global period as a related procedure," modifier 58 applies, Westerfield says. Extend 58 to Anticipated Procedure Whether you should count second surgeries that are unplanned in the surgeon's mind but still staged has been more contentious. Solution: CPT 2008 redefines "staged." The 2007 wording for modifier 58 defines staged as "planned prospectively at the time of the original procedure (staged)," Westerfield says. The new 2008 wording states a staged procedure is "planned or anticipated (staged)." The difference: "Prospective means -expected or likely,- and anticipated means -to look forward to,- " Westerfield says. The AMA may have made this change to try "to more plainly state the reasoning" preceding a staged procedure, she says. Impact: Modifier 58 will apply to staged or related procedures that were "planned or anticipated" at [...]